New Zealand Medical Services in Middle East and Italy
Treatment of the Wounded
Treatment of the Wounded
The casualties on Crete were very heavy, much heavier than in Greece,1 and thus threw a heavy burden on the ill-equipped New Zealand Medical Corps. Medical officers had, however, managed to save many essential parts of their equipment, such as surgical instruments, drugs, and dressings. They were helped considerably by equipment and supplies readily obtained from 7 General Hospital. The lack of transport and the difficulty of evacuating casualties by the one road, which was bombed and machine-gunned incessantly in daylight hours, made it necessary for the MDSs of the ambulances to carry out surgical work, sometimes of a major nature. The surgical team from 1 NZ General Hospital under Major Christie, which had been attached to the ambulances in Greece, was available in Crete; Major Christie performed excellent work and furnished a valuable report on the work carried out under such difficult conditions.
The team was first attached to 5 MDS and then to 7 General Hospital to fill the place of a specialist surgeon killed by a bomb on 18 May. The team was then attached to 189 Field Ambulance hospital at Khalepa until it ceased to function. The force was lucky in having available at 7 General Hospital surgeons of sound training and experience, the senior of them, Lieutenant-Colonel Debenham, later becoming a consultant surgeon on the Western European Front.page 204
Fifth Field Ambulance was called upon to perform a considerable amount of surgical work, both at Modhion and at the site of 7 General Hospital. Sixth Field Ambulance attended to large numbers of wounded from Greece immediately after its arrival in Crete, and later assisted 7 General Hospital by relieving it of its burden of lighter cases and also by setting up a convalescent depot to look after the cases discharged from the hospital. It also treated wounded from the fighting in the Galatas area. Both units assisted the wounded during the evacuation with transport, dressings and rations, and, finally, at the evacuation itself. They nursed and shepherded along large numbers of wounded, some with relatively severe wounds, who normally would not have been permitted to make the trip.
The actual wound treatment varied according to the skill and knowledge of the medical officer and it was natural that some of the surgery was not up to the highest standards. The surgical team reports instances of wounds sutured at the field ambulances with unsatisfactory results. Luckily, there was available our own surgical team and the skilled surgeons at 7 General Hospital, who coped with the greater number of the heavier cases and who had knowledge of the best surgical wound treatment. The wound treatment carried out by our surgical team consisted of débridement, with removal of all soiled and damaged tissue – particularly muscle – with free opening of the wounds and with acriflavine dressings. The serious loss of serum was noted in the large wounds, and also the relative freedom from injury of the nerves and blood vessels.
Fractures: After the usual wound treatment the cases were splinted as follows:
Femur: The Thomas knee splint was used and our surgical team employed a special technique. From ankle to mid-thigh was enclosed by two Cellona plaster bandages. A strong calico bandage was laid on this, passing over a spreader below the foot and coming up on the other side of the limb. Three more Cellona bandages were put on over this. The limb, complete with its plaster casing and extension, was now placed in the Thomas knee splint, the calico attached to the end with rubber tubing – if available – the splint slung from the Thomas crossbar on the stretcher, the footpiece applied, and finally the foot of the stretcher raised to provide extension by the counter body-weight method. This illustrates how one surgeon worked out a combination of plaster and Thomas splintage, which as the Tobruk splint was to become the universal practice later.
Tibia: Plaster closed splint applied.page 205
Humerus: Plaster back slab with collar and cuff, or Kramer wire splints. In fractures of the lower end of the humerus, extension of the elbow below 90 degrees was carried out.
Amputations: These were usually carried out for gross destruction of bone and joint. No guillotine amputations were performed, short anterior and posterior flaps were used, and the site of election was selected. The ends of the wound were sutured, but the central part was left open for drainage. No tubes were used. Main vessels were doubly-ligated and the nerves were simply cut across in the upper part of the wound. In amputations of the lower limb the tourniquet was used, but in the upper limb only digital control of the brachial or subclavian was employed.
In the case of shattered limbs the surgeon employed a simple rubber band just above the lacerated end, to be left on during resuscitation to control haemorrhage, leaving undamaged all the tissue above, through which the amputation would be performed.
Head Wounds: These were excised and the wound closed by use of an S-shaped flap. A head tourniquet was used and an improvised table formed from a stretcher, with a bandage between the bars forming a head rest.
Chest Wounds: These were dealt with very conservatively by aspiration and air replacement. Open sucking wounds, if not already sutured at the field ambulance, were closed, but few of such cases were seen. Detached pieces of rib were removed. No open exploration of the chest was carried out, nor was it ever considered necessary.
Thoraco-abdominal Wounds: All such cases produced by the German explosive bullets were noted to be fatal.
Abdominal Wounds: These were not very frequent. They were all explored at once. The small bowel was generally damaged, the large bowel frequently escaping in a surprising manner, especially in transverse wounds. It was noted that resection of the small intestine caused a heavy mortality. The mesentery and omentum were often found damaged, producing an abdomen full of blood. The rectum was noted to be often injured in sacral wounds, and these cases were generally fatal from toxaemia and probable peritoneal infection. No such case survived, although one lived for five days after a transverse colostomy. The bladder was sometimes injured and catheterisation was always resorted to if any doubt existed, and an in-dwelling catheter left in if any bladder injury was present. No cases of liver, stomach, or splenic injury were encountered.
Shock and Haemorrhage: Treatment consisted of the application of warmth by hot bottles, the relief of pain by morphia (gr. ½) and the splintage of fractures, the elevation of the foot of the stretcher, page 206 and the giving of fluids by mouth, rectally, subcutaneously, and intravenously. Some Baxter vacolites were available at the MDS.
Dried plasma in limited amounts was available at one field ambulance. It was necessary to cut down on the vein and use a cannula. Blood was not used, though transfusion sets and citrate were available at 189 Field Ambulance. The intensity of the surgical inundation precluded its use. The suggestion was made that a special blood transfusion team, consisting of a medical officer and two orderlies, should be attached to the Division, with supplies of dried plasma, a portable refrigerator, and a few pints of blood ready for use.
Gas Gangrene: Only one fulminating case was seen by Major Christie, with infection spreading up to the umbilicus; death occurred twelve hours after admission to hospital. Several cases of limb wounds showed gas in the tissues. These were treated by excision of muscle and muscle groups, and freely opened to facial planes. No amputations were necessary for this condition. Serum was given.
Lieutenant Ballantyne saw several severe cases at 6 ADS and cases were seen later after evacuation of prisoners to Greece.
Sulphonamides: A dosage of 2 grammes, followed by 1 gramme in two hours and then four-hourly for forty-eight hours, was given by the mouth to seriously wounded cases. No sulphonamide was used locally on the wounds.
Foreign Bodies: These were removed when readily accessible or large, but otherwise no time-consuming search was made.
Severity of Wounds: It was noted that the German wounded had much less severe wounds than our own men. The German aerial bomb, trench mortars, explosive machine-gun and cannon-gun shells inflicted more severe wounds than our .303 bullets. The Schmeisser bullet was as severe as a machine-gun wound, if fired at close quarters.